ObjectiveTo explore the clinical characteristics and risk factors for 30-day mortality in hospitalized patients with bloodstream infections (BSI) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). MethodsData were obtained retrospectively from the electronic medical records of inpatients at a tertiary A-grade hospital in Shanghai from January 2016 to December 2023. The collected variables included age, gender, department, surgical treatment, empirical antibiotic therapy, Pitt Bacteremia score (PBS), Charlson comorbidity index (CCI), INCREMENT-CPE score (ICS), length of hospital stay, the time from CRKP-BSI to discharge and, etc. The follow-up period ended upon discharge, with the follow-up outcomes defined as in-hospital mortality or discharge. The endpoint was defined as death within 30 days (including day 30) caused by CRKP-BSI or infection-related complications. Patients who survived within 30 days after CRKP-BSI were classified into the survival group, while those who died within 30 days were classified into the death group. Independent risk factors for 30-day mortality in patients with CRKP-BSI were analyzed using univariate and multivariate Cox regression analysis. ResultsA total of 71 hospitalized patients with CRKP-BSI, comprising 51 males and 20 females, with an average age of (65.12±18.25) years, were included during the study period. The M (P₂₅, P₇₅) of hospital stay were 37.00 (24.00, 56.00) days, and M (P₂₅, P₇₅) of the duration from CRKP-BSI to discharge or death were 18.00 (7.00, 35.00) days. There were 20 deaths (28.17%) in the death group and 51 survivors (71.83%) in the survival group. The results of multivariate Cox regression analysis showed that the ICS as an independent risk factor for 30-day mortality in CRKP-BSI patients (HR=1.379, 95%CI: 1.137‒1.671, P=0.001). Each 1-point increase in the ICS was associated with a 37.9% increase in the risk of mortality. ConclusionThe ICS is found to be a risk factor for 30-day mortality in patients with CRKP-BSI, which may facilitate the prediction for the risk of 30-day mortality and thereby support clinical decision-making for patients with CRKP-BSI.

Objective To explore the correlation and dose-response relationship between blood lipid parameters and the risk of thyroid nodules (TNs) in euthyroid women, providing references for disease prevention. Methods A case-control study was conducted, including 1 412 euthyroid women (701 in the case group and 711 in the control group). Crude and multivariable logistic regression models were used to assess the association between blood lipid parameters and the risk of TNs, and restricted cubic spline regression was applied to explore the dose-response relationship. Results Compared with women in the lowest quartile of serum triglyceride (TG; Q1, TG≤0.92 mmol/L), the risk of TNs was 45% (OR＝1.45, 95%CI 1.06-1.98) higher for those in Q2 (TG 0.93-1.24 mmol/L), 101% (OR＝2.01, 95%CI 1.47-2.77) higher for those in Q3 (TG 1.25-1.81 mmol/L), and 67% (OR＝1.67, 95%CI 1.19-2.33) higher for those in Q4 (TG>1.81 mmol/L) after adjusting for age, body mass index (BMI) and education. For each unit increase in log₁₀TG, the risk increased by 98% (OR＝1.98, 95%CI 1.14-3.45). Moreover, the correlation remained statistically significant even after further adjustment for thyroglobulin antibody (TGAb), thyroid peroxidase antibody (TPOAb) and urinary iodine (OR＝1.75, 95%CI 1.00-3.06, P＜0.05). However, correlations of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) with the risk of TNs were not statistically significant. Restricted cubic spline regression analysis further demonstrated the non-linear dose-response relationship of TG levels with the risk of TNs. Specifically, the risk of TNs increased in a monotonic manner at lower TG concentrations (＜1.23 mmol/L), but appeared to plateau or even slightly decrease at higher levels of TG (≥1.23 mmol/L). Conclusions Among euthyroid women, higher serum TG level is associated with risk of TNs, and this correlation is non-linear.

Objective:To explore relevant factors to accurately diagnose BPPV in vertigo children. Methods:A retrospective study was conducted on the proportion of BPPV in children（<18 years） with vertigo who visited the Hearing and Vertigo Diagnosis and Treatment Center of Tianjin Medical University General Hospital from September 2017 to August 2023. The clinical characteristics of BPPV children, including general demographics, medical history, first visit department, comorbidities, canal involvement, response to treatment, and incidence of recurrence, were analyzed. Data analysis was conducted using SPSS 25.0 software. Results:BPPV was diagnosed in 22.8% of patients seen for vertigo during the study period. There are differences in the proportion of BPPV diagnosis among children with dizziness in different age groups（P<0.05）, and the diagnosis of BPPV in the 7-12-year-old group has a longer disease course than in the 13-17-year-old group（P<0.05）. 72.3%（47/65） of patients or their families were able to provide a typical history of positional vertigo. 49.2%（32/65） of BPPV patients had comorbidities, and there were differences in the proportion of comorbidities among different age groups of BPPV patients（P<0.05）. With the progress of study, the proportion of BPPV in children with vertigo has shown an upward trend, and the proportion of children with otolaryngology as the first diagnosis department has also increased（P<0.05）. The proportion of horizontal semicircular canals in children with BPPV has increased. All BPPV patients underwent canalith repositioning maneuvers, with good treatment outcomes and a recurrence rate of 12.3%（8/65）. The recurrence rate in the group of BPPV patients with comorbidities was 21.9%, which was higher than that in the group without comorbidities（P<0.05）. Conclusion:Childhood BPPV has clinical characteristics such as unclear medical history, high proportion of comorbidities, easy recurrence in BPPV children with comorbidities and high proportion of horizontal semicircular canal involvement. For children diagnosed with other vertigo diseases, do not ignore the BPPV diagnostic test. It is recommended to perform routine position tests on children with vertigo if conditions permit to reduce missed diagnosis of BPPV in children.
Humans ; Benign Paroxysmal Positional Vertigo/diagnosis* ; Child ; Retrospective Studies ; Adolescent ; Female ; Male ; Recurrence ; Vertigo/diagnosis* ; Comorbidity ; Child, Preschool

Peri-implant keratinized mucosa (PIKM) augmentation refers to surgical procedures aimed at increasing the width of PIKM. Consensus reports emphasize the necessity of maintaining a minimum width of PIKM to ensure long-term peri-implant health. Currently, several surgical techniques have been validated for their effectiveness in increasing PIKM. However, the selection and application of PIKM augmentation methods may present challenges for dental practitioners due to heterogeneity in surgical techniques, variations in clinical scenarios, and anatomical differences. Therefore, clear guidelines and considerations for PIKM augmentation are needed. This expert consensus focuses on the commonly employed surgical techniques for PIKM augmentation and the factors influencing their selection at second-stage surgery. It aims to establish a standardized framework for assessing, planning, and executing PIKM augmentation procedures, with the goal of offering evidence-based guidance to enhance the predictability and success of PIKM augmentation.
Humans ; Consensus ; Dental Implants ; Mouth Mucosa/surgery* ; Keratins

Objective To construct a Type 1 diabetes model in miniature pigs and explore postoperative care strategies for effectively prolonging the survival time of the model pigs.Methods Seven Banna miniature pigs were selected for pancreatectomy.Glucose,vitamins,and antibiotics were administered for 3-5 days after surgery to aid recovery.Blood glucose and urine glucose levels were measured twice a day in the morning and evening to adjust insulin supplementation accordingly.The model pigs were observed daily and records were kept,including orexis,psychosis,weakness,skin ulcer,and feces and urine.Body weight was measured weekly until the death of the model animals.Based on the model pigs'condition,glucose injection and Ringer's lactate solution were administered to supplement nutrition and correct electrolyte imbalances.Results All seven Banna miniature pigs showed typical symptoms of diabetes:random blood glucose levels higher than 11.1 mmol/L after pancreatectomy,far exceeding the average blood glucose level of 6.0 mmol/L in normal pigs;positive urine glucose;and progressive weight loss.These features indicated the successful construction of Type 1 diabetes model.Additionally,Type 1 diabetic pigs that survived more than 8 weeks showed progressive hair loss and skin ulceration.Euthanasia was performed on model pigs when they were unable to stand or even eat independently,and pathological examination and HE staining were conducted on tissues collected from affected organs such as the liver,kidneys,and skin.Pathological sections revealed liver congestion,massive glycogen accumulation,ballooning degeneration of hepatocytes,and progressive liver fibrosis,along with glomerular congestion,vacuolar degeneration in renal tubular epithelial cells,proteinuria,dermal congestion,thinning of vascular walls,and varying degrees of parakeratosis and dyskeratosis in the liver,kidneys,and skin tissues due to prolonged hyperglycemia.The average survival time of the constructed Banna miniature pig diabetes model was 44 d,with a maximum survival time of 121 d.Conclusion Type 1 diabetes model can be constructed successfully in Banna miniature pigs through pancreatectomy.With meticulous postoperative care,a long-term Type 1 diabetes model with significant complications can be achieved,providing a stable large-animal model for Type 1 diabetes treatment strategies.

Objective To understand the use of the corresponding scenarios of digital transformation of"convenient medical service"in Shanghai municipal hospital outpatient department from the perspective of patients,and to provide relevant suggestions for promoting digital transformation.Methods A questionnaire survey was conducted among outpatients in Shanghai municipal hospitals to understand the use of digital transformation scenarios and their cognition of digital transformation,and the hypothesis was verified from the perspectives of technology,environment and social factors through the Technology Acceptance Model.Results A total of 4 285 valid questionnaires were collected.The top three scenarios used in outpatient digital transformation are"Precise Appointment"(71.18％),"Convenient Payment"(67.47％)and"Electronic Ticket"(48.87％).Patients'positive experience of friendly interface,stable system,recommendations from relatives and friends and social media significantly and positively influenced their perceptions of technical usability and usefulness.Positive feelings of technical usability and usefulness also encouraged patients to accept and promote digital transformation more actively(P＜0.001).Conclusion The use scenario of patients'outpatient digital transformation is closer to the core medical treatment process.The construction of relevant digital scenarios requires the joint promotion of medical institutions and society.The age-appropriate process transformation for elderly patients needs to reflect humanistic care.

Objective To understand the use of the corresponding scenarios of digital transformation of"convenient medical service"in Shanghai municipal hospital outpatient department from the perspective of patients,and to provide relevant suggestions for promoting digital transformation.Methods A questionnaire survey was conducted among outpatients in Shanghai municipal hospitals to understand the use of digital transformation scenarios and their cognition of digital transformation,and the hypothesis was verified from the perspectives of technology,environment and social factors through the Technology Acceptance Model.Results A total of 4 285 valid questionnaires were collected.The top three scenarios used in outpatient digital transformation are"Precise Appointment"(71.18％),"Convenient Payment"(67.47％)and"Electronic Ticket"(48.87％).Patients'positive experience of friendly interface,stable system,recommendations from relatives and friends and social media significantly and positively influenced their perceptions of technical usability and usefulness.Positive feelings of technical usability and usefulness also encouraged patients to accept and promote digital transformation more actively(P＜0.001).Conclusion The use scenario of patients'outpatient digital transformation is closer to the core medical treatment process.The construction of relevant digital scenarios requires the joint promotion of medical institutions and society.The age-appropriate process transformation for elderly patients needs to reflect humanistic care.

Objective To understand the use of the corresponding scenarios of digital transformation of"convenient medical service"in Shanghai municipal hospital outpatient department from the perspective of patients,and to provide relevant suggestions for promoting digital transformation.Methods A questionnaire survey was conducted among outpatients in Shanghai municipal hospitals to understand the use of digital transformation scenarios and their cognition of digital transformation,and the hypothesis was verified from the perspectives of technology,environment and social factors through the Technology Acceptance Model.Results A total of 4 285 valid questionnaires were collected.The top three scenarios used in outpatient digital transformation are"Precise Appointment"(71.18％),"Convenient Payment"(67.47％)and"Electronic Ticket"(48.87％).Patients'positive experience of friendly interface,stable system,recommendations from relatives and friends and social media significantly and positively influenced their perceptions of technical usability and usefulness.Positive feelings of technical usability and usefulness also encouraged patients to accept and promote digital transformation more actively(P＜0.001).Conclusion The use scenario of patients'outpatient digital transformation is closer to the core medical treatment process.The construction of relevant digital scenarios requires the joint promotion of medical institutions and society.The age-appropriate process transformation for elderly patients needs to reflect humanistic care.

Objective To understand the use of the corresponding scenarios of digital transformation of"convenient medical service"in Shanghai municipal hospital outpatient department from the perspective of patients,and to provide relevant suggestions for promoting digital transformation.Methods A questionnaire survey was conducted among outpatients in Shanghai municipal hospitals to understand the use of digital transformation scenarios and their cognition of digital transformation,and the hypothesis was verified from the perspectives of technology,environment and social factors through the Technology Acceptance Model.Results A total of 4 285 valid questionnaires were collected.The top three scenarios used in outpatient digital transformation are"Precise Appointment"(71.18％),"Convenient Payment"(67.47％)and"Electronic Ticket"(48.87％).Patients'positive experience of friendly interface,stable system,recommendations from relatives and friends and social media significantly and positively influenced their perceptions of technical usability and usefulness.Positive feelings of technical usability and usefulness also encouraged patients to accept and promote digital transformation more actively(P＜0.001).Conclusion The use scenario of patients'outpatient digital transformation is closer to the core medical treatment process.The construction of relevant digital scenarios requires the joint promotion of medical institutions and society.The age-appropriate process transformation for elderly patients needs to reflect humanistic care.

Objective To understand the use of the corresponding scenarios of digital transformation of"convenient medical service"in Shanghai municipal hospital outpatient department from the perspective of patients,and to provide relevant suggestions for promoting digital transformation.Methods A questionnaire survey was conducted among outpatients in Shanghai municipal hospitals to understand the use of digital transformation scenarios and their cognition of digital transformation,and the hypothesis was verified from the perspectives of technology,environment and social factors through the Technology Acceptance Model.Results A total of 4 285 valid questionnaires were collected.The top three scenarios used in outpatient digital transformation are"Precise Appointment"(71.18％),"Convenient Payment"(67.47％)and"Electronic Ticket"(48.87％).Patients'positive experience of friendly interface,stable system,recommendations from relatives and friends and social media significantly and positively influenced their perceptions of technical usability and usefulness.Positive feelings of technical usability and usefulness also encouraged patients to accept and promote digital transformation more actively(P＜0.001).Conclusion The use scenario of patients'outpatient digital transformation is closer to the core medical treatment process.The construction of relevant digital scenarios requires the joint promotion of medical institutions and society.The age-appropriate process transformation for elderly patients needs to reflect humanistic care.